Provider Demographics
NPI:1649339714
Name:ANGELES DENTAL CORPORATION
Entity type:Organization
Organization Name:ANGELES DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GODOFREDO
Authorized Official - Middle Name:CASTELO
Authorized Official - Last Name:ANGELES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-767-4215
Mailing Address - Street 1:8025 WEBB AVE
Mailing Address - Street 2:STE. B
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1505
Mailing Address - Country:US
Mailing Address - Phone:818-767-4215
Mailing Address - Fax:818-767-4483
Practice Address - Street 1:8025 WEBB AVE
Practice Address - Street 2:STE. B
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1505
Practice Address - Country:US
Practice Address - Phone:818-767-4215
Practice Address - Fax:818-767-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG92074-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty